Title

Reduction of Antipsychotic use in Patients with Dementia Residing in Nursing Homes

Date of Award

Winter 2018

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

nursing

Degree Name

Other

First Advisor

Joanne Samuels

Second Advisor

Donna Pellitier

Abstract

Abstract

Residents of nursing homes diagnosed with dementia have long been treated with psychotropic drugs for the symptoms of behavioral disturbances that are frequently associated with major neurocognitive disease. Specifically, the antipsychotic drugs have been widely used in this population. Despite a lack of evidence, antipsychotic rates have shown up to 25% of dementia patients in nursing homes (NH) are prescribed these drugs. This off-label use is not FDA approved for behavioral symptoms of dementia and the drugs have been given a black box warning related to the risk of serious and potentially irreversible side effects and even an increased risk of mortality. CMS has initiated goals for the nation’s NHs to lower the use of antipsychotics related to potential for harm and the annual cost of an estimated thirteen billion dollars in drug claims. The abundant literature reveals studies about this health care safety concern, producing multiple quantifiable methods impacting treatment practices with dementia patients, yielding an outcome of lowered antipsychotic rates. The QIP intervened in the current treatment of dementia patients receiving the drugs at a SNF. Educational meetings and behavioral rounds with nursing staff and prescribers were operationalized. Antipsychotic rates were obtained pre and post intervention and data were collected from a CASPER report. The pre/post rates were analyzed by comparison and interpreted. The findings of the QIP demonstrated translational evidence that can improve the quality of the health care treatment and process of care for dementia patients residing in NH.

Keywords: antipsychotic agents, dementia, adverse effects, mortality, antipsychotic dose reduction, education

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